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Helping the Most Vulnerable Infants, Toddlers, and Their Families

Executive Summary

Compelling evidence from neuroscience about how early
relationships and experience influence the architecture of the
brain,
1 and in turn early school
success, has led to increasing policy and practice attention to
implementing child development and family support programs like
Early Head Start for infants and toddlers.

But, there is also a group of babies, toddlers, and parents who
face so many risks that programs like these alone may not be
enough. This issue brief focuses on the special challenges of
helping babies and toddlers whose earliest experiences,
environments, and especially relationships create not a warm and
nurturing atmosphere, but what scientists have called “toxic
stress”—exposing them to such high and consistent
levels of stress that their growing brains cannot integrate their
experiences in ways that promote growth and learning. It describes
10 strategies that programs and communities can implement to ensure
these babies, toddlers, and families are connected to sufficiently
intensive supports that can get them on a path to early school
success.

Defining Vulnerability: Empirically-based Approaches

Given the challenge of using scarce resources for these infants
and toddlers in the most effective way, it is important to define
the parameters for vulnerability with even more specificity.
Currently, there are three approaches to identifying levels of risk
in young children, all based in some way on empirical and
theoretical developmental science:

Risk indices that reflect some combination of demographic,
child, family, and environmental risks, for example, being a single
parent, receiving public assistance, being neither employed nor in
school or in job training, being a teenage parent, and lacking a
high school diploma or GED. Twenty-six percent of the families
enrolled in Early Head Start experienced four or more of these risk
factors. That sub-sample of Early Head Start families did not
benefit from the program in the same way that other families did.
2

Identifying young children in circumstances known to place them
at risk by virtue of their exposure to ineffective parenting or
parental absence. These include:

–The more than 150,000 young children under age 6 in
foster care in 2003, including 25,000 infants.
3

– Over 300,000 young children with incarcerated parents
(half of whom are infants and toddlers).
4

– An estimated 550,000 young children in homeless
families.
5 (There are no separate figures
for infants and toddlers.)

– The just over 175,000 infants and toddlers who were
victims of substantiated abuse and neglect in 2003. (Infants and
toddlers have the highest rate of victim investigations—16.4
per 1,000—and are most likely to suffer a recurrence.)
6

Using prevalence data based on parental risk factors known to
impair effective parenting. Impaired parenting—defined as
harsh, inconsistent, or indifferent parenting—is known to be
related to poor developmental and emotional outcomes in young
children.
7 Factors that place young
children at serious risk for such parenting include maternal
depression, substance abuse, domestic violence, and—although
we lack even estimates of national prevalence rates—the
parents’ own unaddressed childhood or current trauma. A
prevalence-based parental risk perspective includes:

– The estimated 10 percent of all young children who live
with parental substance abuse/dependence.
8

– The estimated 1.4 million to 4.2 million young
children who experience domestic violence.
9

– Young children whose parents have either clinically
diagnosed or clinically significant symptoms of depression, often
with other risks as well. For example, in a recent study of Early
Head Start parents, a stunning 48 percent of the parents had
depressive symptoms.
10

Appropriate Goals for Interventions Targeted to the More
Vulnerable Infants, Toddlers, and Families

Even in the most high-risk families, unless a child’s
safety is at stake, the best way to promote healthy development and
reduce risks is to help the baby’s parents and other
caregivers. In general, research supports an integrated
four-pronged approach:

Strategy 7: Screen for and address maternal depression and other
risks in health care settings serving women and young children.

Strategy 8: Implement parenting curricula and informal support
groups designed for higher-risk families.

Strategy 9: Build a community approach to prevention and early
intervention for groups of babies, toddlers, and families facing
special risks.

Strategy 10: Include more vulnerable families in broader infant,
toddler, and early childhood advocacy strategies.

Moving Forward

Even in the face of continuing budget cuts, high staff turnover
rates, and often times greater demands on those who work directly
with the most vulnerable babies and toddlers and their families,
programs and communities have been able to:

Develop effective outreach and engagement strategies to provide
earlier interventions to those at greatest risk.

Provide services at critical times of need, such as police
involvement and domestic violence support services.

Enhance collaboration across systems and service providers,
such as child welfare services and early intervention
services.

Mobilize the needed range of skills and staff to address the
range of family needs, such as drug and alcohol treatment, early
childhood development services, early intervention, psychologists,
health practitioners, and social workers.

Provide mental health support and reflective supervision
practices for staff working with the highest-risk families.

Important challenges both from a resource as well as a clinical
perspective also face the field. These include the need to:

Develop culturally appropriate and effective treatments for
both parent and child depression and mental illness, particularly
for immigrant and refugee families.

Find and retain high-quality and appropriately skilled staff
and provide resources to address staff depression and job stress
among those working directly with infants and toddlers.

Promote a research agenda among local programs that includes
not only outcome data, but also information on how well programs
are actually implemented. Lessons from Early Head Start evaluations
suggest that this is key to moving to a new level of program
effectiveness.

Ten Principles to Guide Policy, Practice, and Advocacy

Start with the parents, but connect with the whole
family—not just the mother and the young child—and
don’t forget the fathers, wherever they are.

Work in partnership with community leaders (promoters, mentors,
resource moms, and others).

Target important moments and transitions in families’
lives (such as pregnancy, birth, entrance into early childhood
programs, probation/incarceration).

Connect with families as early as possible (starting during
prenatal care is best).

Connect with families across as many settings as possible (such
as churches, other faith-based organizations, informal child care
providers, and resource and referral agencies).

Use multiple entry points for access to family-focused
screening, assessment, prevention, and more intensive treatment
(such as community health clinics, family court, juvenile justice
system, substance abuse programs, and shelters).

Make sure that parenting programs are responsive to the special
needs of more vulnerable families.

Nurture the staff. Make sure there are supports for child care
staff that are depressed, stressed, and burnt out (such as access
to early childhood mental health consultation).

Find ways to use existing funding more efficiently, and then
seek new funding for specific purposes.
11

Train the next generation of professionals with real families
as their teachers, especially families who have overcome burdens.
For example, assign medical and other graduate students for a year
to a family with a new baby to understand the context of stressed
families’ daily lives, their celebrations, and
hardships.

Conclusion

Each year, over 4 million young children are born, many of them
into loving, nurturing homes regardless of family income. For those
less fortunate, it is in the public interest to invest in
interventions that can help change a negative development course to
a positive one. The strategies highlighted in this document provide
a framework with which to start. Helping the most vulnerable
infants, toddlers, and parents is not easy, but if we fail to do
so, the consequences will most surely spill over into the next
generation.

6. Gaudiosi, J. A. (2003). Child maltreatment, 2003. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, Children’s Bureau, Table 3-8: Victimization Rates by Age Group, 2003 and Table 3-9: Percentage of Victims by Single Year of Age, 2003.